Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2005 -00062
Ifit DEVELOPMENT SERVICES DATE ISSUED: 3/24/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA SR027
SITE ADDRESS: 15298 SW GREENFIELD DR ZONING: R -
SUBDIVISION: SUMMIT RIDGE LOT: 027 JURISDICTION: TIG
Project Description: New SF
BUILDING
REISSUE: DM170 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,570 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,620 sf GARAGE: 407 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5
VALUE: 309,626 10
OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,190 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC FDR: SIGN /OUT UN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVI E W S ECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
This permit is subject to the regulations contained in the
Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes
DON MORISSETTE COMM UNITES LL( DON MORISSETTE COMMUNITIES LL and all other applicable laws. All work will be done in
4230 GALEWOOD ST # 100 4230 GALEWOOD ST #100 accordance with approved plans. This permit will expire
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 if work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules
Phone: 503_387_7538 Phone: 503 adopted by the. Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
Reg #: LIC 162512 direct questions to OUNC by calling 503 - 246 -6699 or
TOTAL FEES: $ 8,706.13 1 -800- 332 -2344.
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Engineered soils
Issued By : ,0 - �
� -_� 1 - —_,/1 Permittee Signature
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Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
. • ,
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' Bulldlri I�ermlt Application r 'P'ORyOFFICE :.. . Received City of Tigard Date/By:‘,....) J� Os Y� r- PemntNo.:`l'\S p'Qp(�
13125 SW Hall Blvd,, Tigard, OR 972231 Plan Review ���7
Phone: 503,639,4171 Fax: 503.598 1,960'N* �� � yaarndl�"YP +i� D ate B y: Ak '3 - . Other Perm J W 1` ,u ) el �a 96
Inspection Line: 503.639.4175 � - W Date Ready /By: , Juris: ® See Attached Checklist for
Internet: www,ci,tigard.or.us 1-oOC Notifiei/Method: i �/ �
��— Supplemental Information
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m New construction C" 1 r (] e tnolition 4Y~ Permit fees* are based on the value of the work performed.
V \ '� n«' Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
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Valuation, $ O� `O
❑ 1- and 2- family dwelling ❑ Commercial /industrial i ( L
❑ Accessory building ❑ Multi- family
Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
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Job site address: 1 /x'.2,9 7s , C 1eP.� � , \ (� � C, New dwelling area: • cZ Q square feet
City / State/ZIP:. \ Y� t \ `, Garage /carport area: q 0 -1 square feet
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Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
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iSubdivision: xy-\NA kV-- 2,cAcy Lot no.: 0 Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
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work indicated on this application.
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Valuation: $
Existing building area: square feet
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^ New building area: square feet
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a EROTERTS37l}� OWNER f - F �,; �,, �� >� „ . T NANT . , u,; a• ; , 4 , Number of stories:
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Name: I -t - • CO M:M tit �° it / L- L-0.) Type of construction:
Address: " l�'�t,� /p f � �--
C.-:. �� � �T , � r,� Occupancy groups:
City /State /ZIP: L-, lei C.0. J4 &P 7 , (I - 20 3 Existing:
Phone: (�,�) ).--) y 5� Fax: () 3 C — 1.aC New:
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Business name: 5 E NS 1''1 .:j l✓ : ' l l n nt ctor nd subcontractors r required b i?t'`? :
All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
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Business name:
. , -0 BUILDIN E a• 4 h t
Address: 6'. .. ._=. •i1i .?t,+ .�r,-, 'F s„!s` +' ...- ;6 ^: ,:r
Please refer to fee schedule.
City /State /ZIP:
' Fees due upon application
Phone: ( ) Fax: ( )
-
CCB lic.: — Amount received
Date received: '
Authorized signature: . l���/
f ^ � V .,...- . � O ft � This permit apptication expires if a permit is not obtained
1J V�'� / within 180 days after it has been accepted as complete.
,. Print name: i A , ( - Date di 1 IC • * Fee methodology set by Tri- County Building Industry
Service Board.
/: \ Building \Permits \BUP PermitApp.doc' 12/03 440- 46I3T(I I /02 /COM /WEB)
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. Plumbing Permit Application ' :FOR OFFICE .USE ONL 1
City Of Tigard E!iew eived
� ` Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 , �/ . A � ar i�p�olp�i M1l ) ' ' , ,h
L DateBy: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 c-�"'f ._ I Juris: ffl s p age 2 f
Internet: www.ci.tigard.or.us z W Not fie od: Supplemental Information
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I�New construction ❑ Demolition For special information use checklist.
7 Description i Qty. Ea. Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
F,
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AG 'CON TR� �•CI T � `'���
O S, U Y ONF - SFR 1 bath
L - �" '
�: 'Fi:' 249.20
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath /kitchen 45.00
❑ Master builder ❑ Other:
„: :.:: _.,:,y.,: _ :.: : :`r. , ;{ - Fire sprinkler ( sq. ft.) Page 2
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OB "SITE��` F'� R1GhATI D:� IsOC'. IO�- ;,,
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- i rif. , Site utilities .
Job site address: N.)3 Green cl Q � ix )('. Catch basin or area drain 16.60
City /State /ZIP: l I gac I v Drywell, leach line, or trench drain 16.60
Suite /bldg, /apt. no.: J I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 'VA ��� j P I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: ` � Fixture or item
w :: ,. : ; ;_ :a:,:rr,,.:r a .exr ,, • •- .;.: , t;t• s s ,,,- , ,: F= Absorption valve 16.60
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`f + +. iAs %r �r$h,U� - ., -.S'a. �'� %«• :�', �; t?. - s,a,r, :4,'.F'. }�..y3nC:'t��i., ; ?;
= Jwl '' sDES CRIPTION ,.OF:WUR,,,, „p:v,:. : ?,..a
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. ,_:.:r �_ .....,.. � _ �..�,: ,,...a�_�Y� < �...,,.� - ,,,,r....,�•t >�. `���..,__..� ._��� ;x <,r...,.�.��.F,..,_.�... ,,. <.. Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
s:. :,,,:: ; :G; , °,,,, ;, s +'.IS:c <: ;ti,,;: .a:s ; < z,; , k,Fr x== .,,;`:,a;•• Drinking fountain 16.60
'�;_' .e:4 ® ",p RSI'1'•'- '�� ^e:,wr:' =•��'�'� < -�_ r.E. >,�:-= •.,:,..'.,
. O ,E .:OWER,-,: sa�1,;."<: ni`:vrys:, v` ,1TENA1�iT .�,;a;:,nsc�: :N: , ^,
,-;,. ,.2 �:e.�sx -, + A' �§ s�- a�-: �c„ r,, N�:' �. �o-r is:.. a..,,_<k.:,:.:- i �"v.ir.- ,..':r - :kR?1�... x...,�;;„ a;wr...ac�'rea, ,,, a: =.�s.4..:2:.z
� Ejectors /sump 16.60
Name: i ii." \j) � c of) man L 'tie , L -Z,(' �, Expansion tank 16.60
Address:1--0. ;levurt GI , s�. ca , L Fixture /sewer cap 16.60
City/State /ZIP: t, , J ) sge- -r-2) Floor drain /floor sink/hub 16.60
Phone: ) - Fax: ( )may -2� (a( Garbage disposal 16.60
t ;,;: :∎ . ,, , yv.: +: �r•;; .,; 6.4 ;0esr;a: Hose bib ,
`i- APPI;I ANT F.it u 'a "= s ,.a . CONT`ACTi RER e ` Ice maker i
't`i:= Y.. 1:• a:^ 7.: af; K ??hz}!'3�,Vti:'�'�'RT.h'. 7 ..1'.�..`.� . . ... .....::.`.'f.`.t�`.d.. �4�,.'•J ,4UY" -' �:9'n .•:f ",k:{L .li:-,r,- T,
° " "" 16 1660 .60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( ) Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
- - _ _- - i�� : "z'dr, °, ;.;M �; �,a;!r- _ .�,ti'�':;ya rv u;• t a= ., va:. _ �s
Urinal 16.60
•.t•% CONTRA CTOR n� . c
4!1
a. ...r.
. , - Water closet 16.60
Business name: ', - ` C k eyv W ater heater 16.60
Address: 20 :f� �,,'a. Other:
1 . Subtotal
City /State /ZIP: r
� � l �J ` Minimum permit fee: $36,25
Phone: oJ)`-�" ` F ax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 1 0S-7?-4 .- If ^iiimbing Lic. no.: 7 7 -- .3�� Plan review (25% of permit fee)
Authorized signature State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: ,� I'"'- ( 3 P r � - v l I Date: e i a 1..4 ( c ~t This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
is \Building \Permits \PLM- PermitApp.doc 12/03 440 -4616T(IO /02 /COM /WBB)
•
Electrical Permit Application , roil OFFICE' USE ONLY .
I' Received
City of Tigard Date/By: -\-J�5 0d d0 /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � �k� r, d � i k yl, ' 1' � '`� Date/By: Other Permit:
Inspection Line: 503.639.4175 c-' N,, - , -__. Date Ready /By: Juris: Ea See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
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New construction ❑ Addition /alteration /replacement Please check all that apply:
❑ Service over 225 amps, comm'l ❑ Hazardous location
❑ Demolition ❑ Other:
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
-, i- v °"' ` _ CATEGORY :0! OSONSTRUCTIONF, ,,, i 1 00 r of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories EFeeders, 400 amps or more
❑ Multi - family El Master builder ❑ Other:
: P :: ' <<:,: persons u
„k,,:, ['Occupant load over 99 e Manufactured structures or
:o ^r3 < - B':'SITEIa[NEO Ast?ION:�AND- '��T.00AT'IO��. E ••. ' >. RV park
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; 3, ❑E Egress/lighting htin plan P
• ..,..._ ........ . ...._.._..�_.....r~.._,,,,. , .... ,- 5, ._:_., gP
rr,,�� ['Health-care facility ['Other: Job no.: ^� Job site address: �- ee(1�iP� .V C Submit 2 sets of plans with any of the above.
City /State /ZIP: 11 Of...
./ r The above are not applicable to temporary construction service.
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Suite /bldg, /apt. no.: Project name: � 'btu ,.. _t t. FEE��.,SCF EDUL ..,, ...,
Description I Qty. I Fee. I Total , **
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea, add'1 500 sq. ft, or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
;.:• energy, non-residential 75.00 2
:
:r. . . ,,:.:«s,; : s; -,, tt: = , ,,r ;Sa;,; Utnited nergy, non dentia4
i
rs:.' O - .ORK . u , \ ,�4,,., t .;q „yea, .
; �• a f Each manufactured or Y
r
t �:. : � -: ��s .. � =n:`i .; .- ....ti a'. .. ...I,i. .. 2 ^.te`:•' .,.�. ... A�ktn ...
_ �`�, .i, o modular
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
��,,•.t:::• ,. ; , i ,;;=z,. .;,, ,, .
.,;: := _; :pk :� amps 106.85 2
201 amps to 400 am
''�'��Y:. �,:_:'• ;k ' ��L��' i,'va.;_;:.i cos: , -2 :F,;.,,�.'A.,� i - ..�;. '. ;i` P P
''¢'`` ',-. -,Y.5T I' ,> . -.;.. 1,' :i., sIg ANTs'�rW`�u- .'`
„ .'? ;, `i$ "`''' �hr v-. o, � >,.- ., �x to, a"; 9; r�” �; '.;ty�:l,tnrk;FLr`:`k ! . ^:�,t'S "I:t\%">'la r:reN' - .,3 � :`.�' � b•:'.n'•:
'' :, •�, �,'.•,',.. .. �, '3 n =,�. - - ':�<c;:P r 401 amps to 600 amps 160.60 2
Name: cW l `W i , Lt(t 2 601 amps to 1,000 amps 240.60 2
Address: LID. �-�j O' a(.l� , L Over 1,000 amps or volts 454.65 2
/�� / V � _ G / � r '" ) Reconnect only 66.85 2
City /State /ZIP: La, p V
Fax: ) L l✓ ) Z- O Temporary services or feeders installation, alteration, and /or
Co. _- ) � G1 ,•-- 7 7
- & „ - IS relocation
Phone: > J ✓✓ ✓� l 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
'� fi.,:;c'e . zs7 f. ;s t r L ., $ O �,: °,:.,, ; V {k • ; �n :r
: Fg v el , . �< ; A. Fee for branch circuits with
1� ; " APEI • 'C:A1V7�� ? "t °� ® ��'CON%PAC'T�'•.PERS'ON`�`;,:r, - � "` <'r.-':
u '_n- ,o,, -, i^ ,,. -., .;c ti . ,,..,.,:: .. , . - . .t __- - .:> ._ ,........., < .,.., _..r
service or feeder f ee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
a . i,:rr.t: ,.. ,' .::; is
-z _. u t >'i .' ... ....... ,,,,. t::, energy Panel, alteration, or
- - ;.CUN'PRACTORs. - `a. a'��,';i''' .,t. . � „•,;. P
_.': = ---. ....,�,.. _.. ,:. �`r•r.- �e'25; :.._ iti;:�t:� •.,..,. - ,- ,,....,•._,, :._..- .., >` .,,,,.. .,.ov`, ..... i.., ...r._ =r6- ....._as:- .., ^,1.: . .'y ?o
.':, gin, -... :��:,, _ � :: ;
extension. Describe: Page 2 2
, Business name: CA :,.,, �� ✓ �..
Address: w s v LA rh r� kV ) , '� --- 7 Ea ch additional inspection over allowable in any of the above
✓ P e r inspection 62.50
City /State /ZIP: .TI ( a)(8, C � 3 Investi per hour (I hr min) 62.50
Phone: 0 —I'—I ' j( D._ Fax: ( ) In dus tr ial plant per hour 73.75
/1 ( ti- 4 v , ; ry , ' -.t A' ii; EIE'CFRIC %AIS;'iPERMI2 sF,E1 S. rz §` -
CCB Lie.: Lo--1 3- Electrical Lic,�,: j , � Suprv. Lie.: '35 `1� Subtotal
Suprv. Electrician signature, re —
C11 Plan review (25% of permit fee)
Print name: A.C'I� tQ`L -i
r I Date: ph �5 State surcharge (8% of permit fee)
L TOTAL PERMIT FEE
Authorized signature: ' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i. \ Dui Iding \Permits \ELC- PermiiApp doe 12/03 440- 4615T( I o /02 /COM /WEE
. r
Mechanical Permit Application roR USE ONLY
City orTigatd Received Permit . ut No.
13125 SW Hall Blvd., Tigard, OR 97223 Plan R eview
�� � �� — � � ��
Phone: 503.639.4171 Fax: 503.598.1960
�+�i' . " ,� Date/By: Review Other Permit:
Inspection Line: 503.639.4175
Intentet: www.ci.tigard.or.us II Date Re luris See Page for
g Notified/Metlio Metltod: Supplemental Information
,
,,. ,.. ... , a ". - .. ... ,., , x,: >, ..... r .,,.TYPE, OF.. W. tt„ -�',,,,,.::,}., ; >, i 'e: *:
OR$- �. •
.. �• �•< 4.. - R, , .� :... - t`�.,. , , .a, ...,_ ,,,.- .,,.... , _ . - _.. „ .. .... u :.>fr•.4 - �r�' -: ��4: _.0 �� NIMER
�x�.,,,z.< e �,rs,- �,._,.�: r__ •;,:'. CIAI,; �TF) E, �.' �SCFIFD .iJLEu- :USEiGHECKLiIST` ° ; ;
- �,3a'�.... ..:- €�: rl�x, F,.,�'a_k'.ai. .. ... _... �..� :, <._.u:�....;.. <:: c.•- oht_::.y.�...JS'.)r ..r. n:,.� ........ .. ...r.:,.. �� 'I!.::.Y.,;,�<........1a';-}�: v�_.,At. .-fr .. ...> .., {
„ . +�"� ,� `v ,�..�J' , e, s'- t' S.^,_ 1'; [n!5ee�s::C!t:?-a*.:�f.r:n..iti' mfr=;' i. �' YGVd�� _. ^_,.qy'.x.- _,::• ?:�_:::. '_'.s.Ytx� -: air.:rv.•,�:":_r..>_�.i�;..., ra.w:.
N ew construction ❑ Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
�`` performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
•. Fd. .,'te - :T��' i.i.:�'o <:: - yRt'? - .i. ": ,tomti }; ' -_ - ( < F �.s+ a
.a` 4 ;.; C'ATEGORI' =' FF f - : AI F<E ' Y ;
,
O .CONSTRU CTION.:,, �,,,.� - :��1!'zii,; ?' :i
S I ENTI'ALEQ *
.t..:r..., .,- ,._...,_ _..- _ <.r,,. - LTIPIVLENT
❑ 1- and 2- family dwelling 11] Commercial /industrial El Accessory building '``' " ° " ry ' : :e x: <';_:=' .:u "' >`' " '`
For special information use checklist.
Multi-family
❑ Master builder ❑ Other:
Description I Qty. Ea. Total
. JOB=; SITE.;INROIZIXIATION AND LOCATION , , nY 70 Heating cooling
Air conditioning or heat pump
Job site address:
c�l.� - 4 e i . ,� - L _ (requires site plan showing placement) 14.00
` E�
City /State /ZIP: — 1 1G O V \ - i Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite /bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flue /vent for any of above 10.00
Subdivision: Sum AA `t d Lot no.: a
1 y Other: , 10,00
Tax map /parcel no.: Y Other fuel appliances
':` =�:M �g :,� � ">'�^ `Y�C . s , Water heater 10.00
r` , x.,. ^=eta
�?F` ,T Ol`tx� =Ol+�, O ,�,:r, ,.1,, ,,?�• ,;:�:,, ,Y, ,11
. ':�„�r,:r ._, _��: -,'. +, _..r.,. »K m,. r at`t�^r.vl ..., _.,. _'`3., , ,. .n_.L. ":y +L.:JGh.,.,, Y,ar- c;>n.
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
...' '— l.'6 °„',.,,.; a, :;{,:t Chimney/liner/flue/vent
10.00
':1 ' - ` : }s I , ' #' , C y
i r ' 'k'.''r ::a:,_ r�'l.:•< ;., ._ . x , ; ti °..6., »:. == Fie,7. }`;;1.;
=PRO,P,ERT• ;>'f)WIVER, ;.t . ;' , :el i : ; ® > ._T_ Fi1Vi?ilV', ;,.K, r.-
°;; ``;��� �;� .,,, f,.,,. - ',,: "t;� ,:.: �a =:.
,. ;. .. � , .,,:..: Other: 10.00
Name: \ C/v M1 ' . ''.MMXIA\N4J L-It)l,./ Environmental exhaust and ventilation
Address: V t" i ' / , l l. Range hood /other kitchen
llll....11��/// equipment 10.00
City /State /ZIP: . '' I CbKote 6 1 '707/ Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: e . ' -- - "? ;i' Fax: ( — 7 • 0 ( toilet compartments, utility rooms) 6.80
�i:i'. - - c;:'.uh'; -•:x /sa:7 -:.•- ^ „ ", kY; '.,+,: ; • ; •' y ��:., : �:; . <•.t;+.t r „t.�$;.._vu, �s +:-s:w .:.,r�, >:.' .,'anx r: ?..:'- -
,�t. I: Jt. tF. ' =fi” . i' �,f�;�i!a, ,_t„1ut : :•:'� : ,la "., �";� >' ' ��, CF ara�.. F, :�''�' "� ��.,.
. rt.AP .IjI'GtSN T 10.00
;:�� �, ❑- +' „:;� „� , '�r °.f:;„t�,.i�7� {CONY .ACT „EERSO.N- >:,: ; ;;��,. Attic/crawlspace
,v ice .. ..... . .. :.s, , �.__..,..-. ' �'!' f.:”: i' s. s: Flt. a ..,,-.-.. �3.. CU,.• 5st': t. YV' 4' t:.,, �: Pr .iC:b�w...- k:'.._.,.xx-. -:.,t. i 5x1; F+:= r., s i'] r in:rr- ..= .'niir�,�,!, >J''�
Business name:
Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR
:: ... > , . _,.� _ i t n s Barbecue
h 1 -`�„ /� Clothes dryer (gas)
Business name: (� ' J ,' y� %1 � 4 7/ ]� � /`L / /,
r tttccc"`iii C./t.., ` I L/� f / t x_ Other:
Address: //'�� ,:i % "* :; 'i';
,
� • I - ` -I / J /� / �] i : , '!,.:,i z !_ : , , 1VIECI-IA1V^ICAT; P E imiT3F,EE ? : - ,6, 4 :.',
City /State /ZIP: V e 1" �•I ‘. t 0/I'+ C L )()L/ , ,ke rr .,,_, ,a:,R:.,r „!. ",:t5':'_s; Subtotal
.,,.,_...._.:.k .
Subtota
Minimum permit fee ($72.50)
Phone: (C jj g d "�) Fax: ( ) Plan review (25% of permit fee)
CCB lie.: . 507)
— State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: : / 7' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: f b \ — -4 I Date: � 14.4105 * Fee methodology set by Tri- County Building Industry Service Board
i:\Building \Permits \MEC- PennitApp,doc 12/03 440 -4617T (11 /02 /COM /WEB)
V
4
1 STREET EE ATI E TIFI
C C
R
..
..
i ..
® : ..
A 11, 0
I, /L rr , Owner/Agent for ,,,,,,v hiss £ � mwpfb s tGC
(PLEASE PRINT) (PERMIT HOLDER)
A /
y `` w g location ® Do hereby hC{etirt�� t1�:���; =t:l�e foldo; in 1
, "" x ,'d'4�' 3 Y E w$ '.�'e 3 x 3 i 4�
meets „C ty:of1 igar d /Washington County
land use and development standards for street tree installation.
ADDRESS: if..Z . 6ko 6,c ,i/vi = ,f,�,e.
A
A LOT: ,; SUBDIVISION: i.irran1/1" ,e-
4
BY: DATE: 6 -- ,2 -6S
1
1 RECEIVED BY: DATE: 0.
CITY OF TIGARD-
BUILDING DIVISION PERMIT #: MST2005-00062
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/24/2005
Phone: (503) 639 -4171 �mmc >nrylml�i�illl�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/23/2005 TIME: 7:10AM PAGE: 6
SITE ADDRESS: 15298 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 027 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF
OWNER: DON MORISSETTE COMMUNITES LLC, PHONE #: 503 -387 -7538
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503- 387 -7538
Inspection Request Scheduled For: Date: 6/23/20055 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 010008 -02 503. 209.4837 N
Corrections /Comments /Instructions:
mofie; No A/c uu vvs-- )e&,l /e �.
Oe reg,r;•cL ,e 144-4/1(
ZL-FrAg El PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Z3 Phone #: (5 03) 718-
CITY OF TIGARD„
BUILDING DIVISION PERMIT #: MST2005 -00062
.13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/24/2005
Phone: (503) 639 -4171 i ovitubJ i ,t 1 '
Inspection Requests (24 Hrs.): (503) 639 -4175 � . -_..
INSPECTION WORKSHEET FOR DATE: 6/24/2005 TIME: 7 :09AM PAGE: 5
SITE ADDRESS: 15298 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 027 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Never SF
OWNER: N -` ° U T S LL C, #: 5 503
Dt� MGRISSL - TTE CDMM NI E L C, 387 -76:0
1
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503- 387 -7538
. Inspection Request Scheduled For: Date: 6/24 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 010126 -02 503. 209.4837 N
Corrections /Comments/ Instructions:
•
•
-
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 24- -4; Phone #: (503) 718-
i
CITY OF TIGARD,'
BUILDING DIVISION PERMIT #: MST2005 00062
I 13125 SW Hall Blvd., Tigard 4 R 97223 DATE ISSUED: 3/24/2006
I Phone: (503) 639 -4171 / ��m�m a 4M�NPiigpl6� ��; ��
Inspection Requests (24 Hrs.)%'(503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/24/2005 TIME: 7:09AM PAGE: 4
SITE ADDRESS: 15298 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 027 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF Y
OWNER: DON MORISSETTE COMMUNITES LLC, PHONE #: 503 - 387 -7538
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503- 3137 -7538
Inspection Request Scheduled For: Date: 6/24/2005 Pour Time:
Code # Inspection Description Confirm # Contact # • Message
299 Final inspection 010126 -03 503 -209 -4837 N
Corrections /Comments /Instructions:
•
PASS - TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES. ASSESSED
Inspector: Date: la -- 2 d Phone #: (503) 718-